Provider Information for 1619543261
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KOMUNI CAMPBELL
Sex: Female
NPI: 1619543261
Last Updated: 2023-09-14
Certification Date: 2023-09-14
Certification Date: 2023-09-14
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1619543261 | ||||||||
| Enumeration Date | 2021-06-02 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 7646 FANNING DR JACKSONVILLE, FL 32244-8155 United States Phone: 404-457-6266 | Fax: | ||||||||
| Primary Practice Address | 1536 N JEFFERSON ST JACKSONVILLE, FL 32209-6525 United States Phone: 904-475-5800 | Fax: | ||||||||
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